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Contractor Section: <br /> ,, \ . vl�� �Jl l � 0 --�7�'Z-�7( '� <br /> Vendor Name/ Business Name/ BI Number <br /> ��(�'I-�G//�� <br /> State of Washington Contractor License Number: <br /> �/� �l V`r � �•���n. �-v�� Y�''�� -�zT t�- q� ��3 <br /> Vendor Mailing Address City Slate Zip <br /> .�J2 �- �{�' �-a/7�3 � P(��, 1��-� L1.0 �u'�� �' l <br /> Phone Emaii <br /> I, the Vendor, agree to recaive the Backwater Prevention Device rebate check diredly for the <br /> inslallation at the above referenced property address. By agreeing to receive ihe rebate c�eck <br /> directly, I agree to the following: <br /> 1. The Backwater Prevention Device rebate amount will be deducted from the final invoice <br /> given to the properiy owner for the installation at the property address referenced above, if <br /> the total cost of the installalion is greater than the rebate. <br /> 2. I, the Vendor, am a Washington State licensed conVactor. <br /> 3. The City of Everett will send a Federal Form 1099 MISC to me, the Vendor,tor Backwater <br /> Prevention Device rebate payments totaling more than $600 per calendar year, and will <br /> report the same payments to the Internal Revenue Service. <br /> I accept the payment of the Backwater Prevention Device rebate from the City of Everett pending <br /> approval of the completed Backwater Prevention Device rebate package by the Ciry o(Everett <br /> � �2_�� _ ��.-- <br /> Signatu f ractor Date <br />